January 19, 2020

Another path to reform

It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Yet prior to the Affordable Care Act, healthcare was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009 I wrote a ” target=”_blank”>It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once and I predict it will cause much disruption and grief.

My last example is the recently passed Sustainable Growth Rate (SGR) “fix” which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of “meaningful use”.

I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.

Two weeks ago my family and I spent 10 days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.

For years passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.

This was an epiphany to me. I had always assumed that fixing the healthcare marketplace would mean political reform – undoing the myriad laws that substituted insurance for healthcare and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now I understand that political reform is both unrealistic and unnecessary.

Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The ” target=”_blank”>LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.

I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it – ICD-10, meaningful use – will never be repealed. This bureaucracy will become the taxi monopolies of healthcare – increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in healthcare will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.

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